Mortality rates from cancer, in general, and cervical cancer, in particular, among Alaska Natives exceed those of the general U.S. population. Furthermore, there is evidence of increasing rates of cervical cancer and severe dysplasia in this population. High rates of factors associated with increased risk of cervical cancer; sexually transmitted diseases including human papilloma virus and chlamydia infection; and smoking have been documented. The long term objectives of this project are to reduce the morbidity and mortality from invasive cervical cancer in Alaska Native women. The specific aims are: to promote knowledge and awareness of this disease, its risk factors and appropriate screening programs; to enhance the existing cervical screening program and follow-up care of precancerous lesions, and to effect reduction in risk factors. The project will be conducted primarily in one large urban and one smaller rural IHS Service Unit within the Alaska Area Native Health Service. The first year of the project (Phase I) will include a survey of knowledge, attitudes, and beliefs (KAB) regarding cancer and cancer screening in general, including cervical cancer, of a randomly selected sample of Alaska Native women stratified by 5 years of age starting at age 15, residence, and ethnic group. The current level of Pap smear screening, stratified by age and residence will also be assessed by examination of available computerized cytology screening data to identify present and future target populations. A separate KAB survey of women who do and do not keep follow-up appointments for colposcopy will identify barriers to follow-up care. The assessment of ongoing studies by the Arctic Investigations Laboratory and the Indian Health SErvice to evaluate other screening methodologies such as testing for Human Papilloma Virus (HPV) cervical infections and cervicography for cervical dysplasia and HPV will be completed during Phase I. Phase II intervention strategies, during project years 2 through 4, will be directed toward reducing barriers to screening and follow-up identified in Phase I and appropriately targeting traditional and new screening methodologies of proven utility. Available and timely follow-up colposcopy and cervical biopsy will be provided regionally by specially trained, mid- level, women's health care providers. They will utilize HPV testing to focus screening resources on those women who are infected and are at highest risk of cervical dysplasia and cancer, they will also provide appropriate treatment of diagnosed cervical infections.